As a hospitalist, I am frequently the admit doc for most patients with multiple medical conditions. While a get asked to consult on patients who have been admitted by another service, often times I am the one asking for the consultation from another specialist. So when a doctor tells me "Thanks for the shitty consult", one is forced into thinking mode to try and define shitty.
What determines whether a consult is shitty or not?
- Time. We all know that time is money. Insurance companies do not pay based on time. Any consult that swings the pendulum from quick and easy to long and hard is a shitty consult. The four box theory of life arranges consults into four possible scenarios. Quick and easy. Quick and Hard. Long and Easy. Long and Hard. The best consult is the quick and easy. The shitty consult is the long and hard. Sorry, I didn't make them sick.
- Money. If the patient does not have insurance, the consult automatically becomes a shitty consult by default. It does not matter if they are the nicest people in the world. It is a shitty consult. As one doctor told me once: "I am not a not for profit entity." Sorry. I didn't make them unemployed.
- Patients who are awake and with it move you toward the long arm of the four box theory. Patients sedated on a ventilator move you toward the quick arm of the four box theory. The more awake the patient, the shittier the consult. Docs, you know it's true, however crass that statement is. Sorry, I didn't make them awake.
- Urgency. Getting called away from insurance paying out patient consults to rush to the hospital for a life threatening condition is a shitty consult. It ruins the day. It costs money. It increases liability. It increases the hard factor and time factor. The more urgent the consult, the shittier it is. Sorry. I didn't make the patient sick.
- Time Of Day. The later in the day the consult, the shittier it is. Middle of the night, say 2ish am? That's a really shitty consult. 5 pm on a Friday afternoon when you are getting ready to go to your daughters dance recital? Shitty. This ties into urgency. If it can wait till morning, it will. Otherwise enjoy the shitty consult. Sorry I didn't make the patient sick.
- In-patient consults. As a rule, inpatient consults are shitty, when compared to outpatient consults. It's true, most specialists would much rather consult on stable outpatients than sick, time consuming inpatients. Sorry, I'm a hospitalist. My consults only come from hospitalized patients. Enjoy the shitty consult.
- Lots of medical problems. The sicker the patient, the shittier the consult. Of course, that may only apply for hospitalists. The consults I receive on patients with 20 medical problems are much harder than the patients I get consulted on with one or two medical problems.
- Non English speaking are shitty consults, mostly because where I live, most doctors only speak English and it's really hard to do a consult by talking really loud and really slow.
- Too many family members in the room? Shitty again. Call me when all the family goes to lunch.
- Hard of hearing and demanding to use a dry erase board to communicate. Oh, the pain.
Others?
Oh, that's easy. When I was in Neurosurg, and later Ortho, prior to switching to EM, the worst consults......
ReplyDeleteSquirrels.
Especially Squirrels with a problem.
By squirrel I am referring to a patient with a personality/Psych disorder or quirk....such as the patient that asks the same questions over and over, or the one that perseverates on something completely unrelated to the problem at hand.
They take up an inordinate amount of time, and create a good deal of frustration.
Sometimes I've found that you just have to cut them off, or you'll never get out of their room. You just need to be polite and professional about it, but good god.
Those were by far, the worst consults. It wasn't so bad, if they didn't have a problem, cause you knew you weren't going to see them again, but when they DID have a problem....you just dreaded rounding on them.
phys...I covered that. #3
ReplyDeleteYeah, but not all patients that are awake are THAT much of a bother. There were, and still are ones that just make you go....OH MY GOD, when you walk out of their room. If I need a consult on one of them in the ED, I usually apologize to the service before they even see them.
ReplyDeleteNice thing about Anesthesia, you're mostly only consulted for IVs and airways... once in a while you get asked for your anesthetic recommendations...I ALWAYS recommend Anesthesia for Surgery, hurts like crap without it...
ReplyDelete"By squirrel I am referring to a patient with a personality/Psych disorder or quirk....such as the patient that asks the same questions over and over, or the one that perseverates on something completely unrelated to the problem at hand"
ReplyDeletegood lord i have happened trough this, in ED!!!! people go to emergency, people tend to forget syptoms like amaurosis, but they dont forget something like, my back hurted 3 years ago, they can give you the story backguards, start telling about their diseases ignoring the first sypmtons, ignoring important sypmtons, not tellling you what is first, second and so on. leading to a lot of time spended in the emergency.
Do you ever tell them "thanks for the shitty consult" when they call you to "clear" a patient? Probably not.
ReplyDeletetracy
ReplyDeleteIm a doctor that works extra hour for the patients without extra paid.
im a doctor that has his luch at midnight cause ER was full and i didnt want to got for 20 min at midday for lunch.
for me my patients arent a problem.
I DONT HAVE TO ARGUE WITH YOU ABOUT MY HUMANITY I THINK I GOT PLENTY, MORE HUMANY THAN A REGULAR PATIENT DOES
me two hour ago
"people go to emergency, people tend to forget syptoms like amaurosis (hello i dont see in eye", but they dont forget something like, my back hurted 3 years ago, they can give you the story backguards, start telling about their diseases ignoring the first sypmtons, ignoring important sypmtons, not tellling you what is first, second and so on. leading to a lot of time spended in the emergency"
that i write right below its the true, you cant or you shouldnt make consults on ER, first of all.
second, patient start to talk about unrelated things, if you explain them and you took the time, they even got the balls to insist on those symptons, after a long explanation they insist over and over, something unrelated to their current ilness, and dont need futher discussion.
if someone with a phys disorder come at night with not people i will kindly hear them and spent some time, even though YOU MUSNT DO THAT ON ER, a er is for critical patients.
i cant attend someone with a regular depresion on the er while someone is having a heart attack i can be sued for that, on the other hand a patient who tried to kill himself, has a top priority in the ER is as dangerous as a heart attack. but this kind of patients need longs hours of dedication talking, ER arent prepared for this, limited personal, too much patients, at least in my country (Venezuela).
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ReplyDeleteThis comment has been removed by the author.
ReplyDeleteopps sorry tracy but know that you mention thats right isnt way to say the things
ReplyDelete